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LCD ID Number: L36711 Status: A-Approved
LCD Title: Intensity Modulated Radiation Therapy (IMRT)
Geographic Jurisdiction: Arkansas Other Jurisdictions
Original Determination Effective Date:
12/01/2016
Original Determination Ending Date:
Revision Effective Date:
01/01/2021
Revision End Date:
CMS National Coverage Policy:
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Intensity Modulated Radiation Therapy (IMRT) services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify, or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for IMRT services and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies services may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site.
IOM Citations:
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
- Chapter 6, Section 20.5.3 Coverage of Outpatient Therapeutic Services Incident to a Physician's Services Furnished on or After January 1, 2020 - Changes to Supervision Requirements
- CMS IOM Publication 100-04, Medicare Claims Processing Manual
- Chapter 4, Section 200.3 Billing Codes for Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS); and Section 200.3.1 Billing Instructions for IMRT Planning and Delivery
- Chapter 13, Section 70.5 Radiation Physics Services
- CMS IOM 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD
Social Security Act (Title XVIII) Standard References:
- Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
- Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
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